BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.95.102, 37.95.128, 37.95.132, 37.95.184, 37.95.623, 37.95.702, 37.95.1001, 37.95.1002, 37.95.1003, 37.95.1004, 37.95.1005, 37.95.1011, 37.95.1015, 37.95.1016, and 37.95.1021 pertaining to infant care
NOTICE OF AMENDMENT
TO: All Concerned Persons
1. On March 22, 2012, the Department of Public Health and Human Services published MAR Notice No. 37-577 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 600 of the 2012 Montana Administrative Register, Issue Number 6.
2. The department has amended ARM 37.95.132, 37.95.184, 37.95.623, 37.95.702, 37.95.1001, 37.95.1004, and 37.95.1021 as proposed.
3. The department has amended the following rules as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:
37.95.102 DEFINITIONS (1) through (12) remain as proposed.
(13) "Group day care home" means a private residence or other structure in which day care is provided to seven to 12 children on a regular basis. In addition to the previous definitional language found at 52-2-703, MCA, the term also means a day care facility providing care to seven to 12 children with no more than six children under two years of age, unless care is provided
for infants only exclusively for children under age two. For facilities providing care only for infants exclusively for children under age two, group day care home means a place in which supplemental parental care is provided for up to eight infants children under age two. No other children shall be in attendance.
(a) through (44) remain as proposed.
(45) "Safe sleep environment" means an environment where an infant is placed in a safety-approved crib with a firm mattress and a firmly fitted sheet or a safety-approved play yard for all naps. For children one year of age or over, a nap mat may be used as long as compliance with ARM 37.95.1005 is met. The infant must be placed on their back and only a light-weight blanket is allowed with the infant. The infant should be dressed in safe garments and provided a smoke-free environment.
(45) through (52) remain as proposed but are renumbered (46) through (53).
AUTH: 52-2-704, 53-4-212, 53-4-503, MCA
IMP: 52-2-702, 52-2-703, 52-2-704, 52-2-713, 52-2-723, 52-2-725, 52-2-731, 52-2-735, 52-2-736, 53-2-201, 53-4-212, 53-4-601, 53-4-611, 53-4-612, MCA
37.95.128 DOCUMENTATION OF THE ABSENCE OF UNUSUAL HEALTH RISKS FOR CHILDREN UNDER AGE TWO (1) A day care facility must have on file a health record form, provided by the department, concerning any special health risks that would affect other children. This must be obtained and kept on file by the provider prior to residence or enrollment of
the infant in the any child under age two at the day care facility. The health record form must be signed by:
(a) through (d) remain as proposed.
AUTH: 52-2-704, MCA
IMP: 52-2-731, MCA
37.95.1002 INFANT'S AND TODDLER'S WET OR SOILED CLOTHING
(1) Wet or soiled clothing shall be changed promptly. Spare clothing shall be available in the event that a child's clothing becomes wet or soiled and it is the responsibility of the parent or guardian to care for the wet or soiled clothing. The clothing shall be placed in a sealed bag and returned to the parent or guardian.
AUTH: 52-2-704, MCA
IMP: 52-2-731, MCA
37.95.1003 INFANT'S AND TODDLER'S FEEDING (1) and (2) remain as proposed.
(3) Bottles shall not be propped. Infants too young to sit in high chairs shall be held in a semi-sitting position for all bottle feedings.
(a) remains as proposed.
(b) Older infants and toddlers shall be provided age-appropriate feeding equipment when being fed
must be fed in safe high chairs or at baby feeding tables. This includes safe high chairs, baby feeding tables, booster seats, and child-size tables and chairs. Use of these types of equipment must be used in accordance with the manufacturer's instructions and must be appropriate for the age of the child using the equipment.
(c) through (6) remain as proposed.
AUTH: 52-2-704, MCA
IMP: 52-2-731, MCA
37.95.1005 INFANT'S AND TODDLER'S, SLEEPING (1) remains as proposed.
(2) Unless the parent has provided medical documentation from a health care provider ordering otherwise,
children under age two infants shall be placed on their back and on a firm surface to reduce the risk of Sudden Infant Death Syndrome (SIDS).
(3) Each infant shall be provided with a crib or play pen for sleeping. At the discretion of the parent and provider,
a toddler may be allowed to sleep on a cot or mat a cot or mat may be used once a child turns one year of age as long as a safe sleep environment is provided. Children one year of age through 18 months who are placed on a mat must have a signed permission statement in the file indicating that the parent has given permission for their child to be placed on a mat. In addition, a caregiver must remain with the child while they are sleeping.
(a) through (9) remain as proposed.
(10) The licensee or registrant of facilities licensed/registered after the enactment of these rules must receive training in an approved safe sleep curriculum before being granted approval for children under age two.
The provider and any Any caregiver who provides care to children under age two must receive training in an approved safe sleep curriculum within 60 days of hire before providing care to children under two. Caregivers who have not received the safe sleep training shall be supervised by an individual who has successfully completed the approved safe sleep curriculum in order for the caregiver to provide care to children under age two. Facilities licensed or registered before the effective date of these rules will have until July 31, 2013 to complete this training.
(11) Providers must develop a written policy that describes the practices to be used to promote a safe sleep environment when children under age two are napping or sleeping.
(12) remains as proposed.
AUTH: 52-2-704, MCA
IMP: 52-2-731, MCA
37.95.1011 INFANT'S AND TODDLER'S, ACTIVITIES (1) remains as proposed.
(2) An infant or toddler who is awake shall not spend more than 30 minutes of consecutive time confined in a crib, playpen, jump chair,
walker, or highchair.
(3) through (5) remain as proposed.
AUTH: 52-2-704, MCA
IMP: 52-2-731, MCA
37.95.1015 INFANT'S AND TODDLER'S, OUTDOOR ACTIVITIES
(1) remains as proposed.
(2) There must be an outdoor play area on the facility property. The play area must be fenced in accordance with ARM 37.95.121 and free of hazards which are dangerous to the health and
life safety of the children. Every time an infant or toddler is outdoors, they must be supervised by a caregiver.
(3) and (4) remain as proposed.
AUTH: 52-2-704, MCA
IMP: 52-2-731, 52-2-736, MCA
37.95.1016 INFANT'S AND TODDLER'S, EQUIPMENT (1)
Feeding tables equipped with a harness or highchairs with a broad base and a harness for securing the infant or toddler, Age-appropriate feeding equipment shall be provided for every four infants or toddlers. This includes safe high chairs, baby feeding tables, booster seats, and child-size tables and chairs. These types of equipment must be used in accordance with the manufacturer's instructions and must be appropriate for the age of the child using the equipment. Portable high chairs that hook onto tables are prohibited.
(2) remains as proposed.
AUTH: 52-2-704, MCA
IMP: 52-2-731, MCA
4. The department has thoroughly considered the comments and testimony received. A summary of the comments received and the department's responses are as follows:
COMMENT #1: A commenter suggested that the term "breast milk" should be placed in front of "formula" in ARM 37.95.1003.
RESPONSE #1: The comment is outside the scope of the proposed changes but the department will consider for future rule changes.
COMMENT #2: A commenter made recommendations to the general meal patterns for infants under the nutrition section.
RESPONSE #2: The comment is outside the scope of the proposed changes but the department will consider for future rule changes.
COMMENT #3: A commenter asked "why not a 6:1 ratio for toddlers? The ratio would fall between infants and preschoolers and clearly establish toddlers as a unique group with unique needs."
RESPONSE #3: The comment is outside the scope of the proposed changes but the department will consider for future rule changes.
COMMENT #4: One commenter requested clarification about when staff needed to be counted in ratios. The commenter wanted to know whether she would count in ratios if she was in another building.
RESPONSE #4: Individuals who are counted in the ratio must be available to directly supervise the children in care. An individual who is in another room or another building would not meet the intent of this rule.
COMMENT #5: There were two comments stating that ARM 37.95.1003(2) is not appropriate for toddler feeding as it seems to go against CACFP regulation of establishing specific meal times and the promotion of family style meal service. One commenter stated that the rule for toddlers also seems to promote the "grazing" habit.
RESPONSE #5: With the exception of adding the word "toddler" to the language in ARM 37.95.1003(2), the rest is existing language. This specific rule does not specify meal patterns. Guidance for meal patterns is found in ARM 37.95.215 and 37.95.711.
COMMENT #6: There were two comments about whether ARM 37.95.1003(2) requires parents to purchase milk for toddlers with special milk requirements. Does it include parents providing the food for children when parents have chosen to be vegetarian?
RESPONSE #6: If a child requires special dietary foods, the provider may accommodate the request. However, if they choose not to, it is the responsibility of the parent to provide the special dietary foods for their own child. This regulation is consistent with CACFP requirements.
COMMENT #7: There were eight comments about other options for feeding children ages 12 months and over. The basic concern was the allowance for child-sized tables and chairs.
RESPONSE #7: The department agrees that further clarification is needed for additional equipment that can be used for feeding. Since the department expanded the equipment that could be used, it was necessary to specify that the use of portable high chairs that hook onto tables may not be used. The department is adding language to ARM 37.95.1003(3)(b) and 37.95.1016(1).
COMMENT #8: Under ARM 37.95.1005(3), there were three comments suggesting that toddlers be allowed to sleep on a cot or mat rather than in a crib. One commenter questioned whether it was safe for a child who is able to climb out of a crib, or appropriate for a child who is almost three years be placed in a crib.
RESPONSE #8: The department agrees that the language needs to include allowances for children, starting at one year of age, to use mats or cots for sleeping. However, it is necessary to provide additional guidance for infants who will be using a cot or mat. The department has amended the proposed rule changes to include the use of cots or mats at one year of age and has also provided additional guidance when this practice is utilized.
COMMENT #9: A commenter stated that in ARM 37.95.1005(8) parents are required to provide a clean washable blanket. The commenter stated that centers are responsible for washing bedding every week as per health department regulations. If parents provide the blanket, centers are unsure if the blanket actually gets washed each week when it is sent home.
RESPONSE #9: The only part of this rule that has changed from the original version was the addition of the word "toddler." The department has allowed facilities to wash the blankets at the facility or send them home with the parent. The department will be reviewing the Interpretive Guidelines and will ensure that this practice is included.
COMMENT #10: There were three comments about ARM 37.95.1005(10). The commenters requested clarification about whether all staff in a facility need to receive safe sleep training as required since not all children are under age two. The comments also addressed the timeframes for completing the training. It was suggested that caregivers be given additional time to complete the training rather than be required to have it upon hire. One commenter mentioned that there may be issues with availability of training.
RESPONSE #10: The proposed rule only requires staff who work with children under age two to receive training in the safe sleep curriculum. The department agrees that the timeframe to receive the safe sleeping training for new staff needs to be extended. Therefore the proposed rule under ARM 37.95.1005(10) has had language added to allow for 60 days from the caregiver's start date to receive the training. However, licensees and registrants must have this training before providing care to infants. Since the department will be amending the timeframe, the department has also added language requiring at least one caregiver who has received the safe sleep curriculum to be available to staff who have not received the training.
The department has consulted with the training sponsor who will be conducting one section of the safe sleep curriculum. The sponsor indicated that the infrastructure is prepared for the increased participants who will need to complete the safe sleep curriculum.
COMMENT #11: One commenter suggested further amending language in ARM 37.95.1021(5), to read: "play areas used by children over 18 months."
RESPONSE #11: The department thinks that the proposed language is sufficient. Although some providers may choose to transition children who have just turned 19 months to an older classroom, other providers may choose to continue to keep children zero to two years together. Therefore, the proposed language will remain as proposed.
COMMENT #12: If infant and toddler changes are implemented in one regulation, it should be changed through the entire child care regulations. As it is written now, the two year regulation still exists in some areas; therefore, it causes confusion as to when the 19 month or two year old regulation can be used. Whenever there is a regulation regarding an "infant," are the licensors going to use 19 months or two years in their count for the number of children present during a visit? This has to be made very clear and not a discretionary point. If this change is to create the ability for the system to care for an increased number of infants, the continuous use of the term "two year" nullifies it.
RESPONSE #12: The department agrees with the commenter and understands that there may be some confusion as a result of the department's proposed changes in ages.
While the department thinks that the proposed age of changes for infants and toddlers better defines the particular age groupings, there are still some areas that require clarification at 12 or 24 months due to developmentally appropriate practices and health or safety of infants and toddlers. The department will be working on a resource, which will serve as a supplement to this rule, for providers. This new tool will help to clarify what is required for children at particular ages with respect to the rules redefining the ages of infants and toddlers.
COMMENT #13: There were three comments regarding whether a higher payment rate would be received for an infant up to 19 months or two years.
RESPONSE #13: This comment is outside the scope of the proposed rule amendments. The comment will be referred to the Early Childhood Services Bureau.
COMMENT #14: One commenter agreed that change to 19 months is a better description of the developmental stage of an infant than does two years.
RESPONSE #14: The department thanks the commenter.
COMMENT #15: There were two comments about the change of the term "Day Care" to "Child Care."
RESPONSE #15: The use of this term is consistent with state law; furthermore, such a change is outside the scope of the proposed rule.
COMMENT #16: One commenter questioned whether the changes to ARM 37.95.1001(9) are measurable. The commenter suggested that it may be advisable to add language to the rule stating "Provider must supply documentation, such as conference notes or a permission form that is signed by the parents stating that it is appropriate to begin toilet training."
RESPONSE #16: The current Interpretive Guidelines address documentation and communication with parents. The department thinks that the current language is measurable and sufficient as written but will further address through the interpretative guideline document.
COMMENT #17: There were three comments stating feeding tables go against NAEYC and ITERS requirements and it was recommended that the use of feeding tables be removed.
RESPONSE #17: NAEYC and ITERS requirements utilize a best practice approach. Although the department understands and supports the use of best practices, the department is charged with providing a rule that addresses the underlying health and safety of children in care. Other than a best practice statement, the department has not found compelling evidence showing that the use of feeding tables creates a health or safety risk to children.
COMMENT #18: One comment was received with regard to ARM 37.95.1011. The rule states that infants and toddlers shall be taken outside for some period of time each day, in good weather. The commenter asked the department to define "good weather". According to the commenter, the term itself is not measurable. Additionally, the commenter goes on to state that The National Association for Family Child Care defines good weather as "wind chill not below 20 degrees F and heat index not above 80 degrees F and not stormy."
RESPONSE #18: The department thinks that the rule is sufficient as it is written. The department has provided a resource that is available on the Child Care Licensing web site that identifies timeframes children should not be exposed to particular temperatures and wind chills.
COMMENT #19: The definition of infant and toddler needs further consideration. According to the National Health and Safety Performance Standards, an infant is defined as a child between the ages of birth to 12 months of age, a toddler is defined as a child between the ages of 13 and 35 months of age, and a preschooler is defined as a child between the ages of 36 and 59 months of age. Furthermore, several states define infants, toddlers, and preschoolers in this way. The National Health and Safety Performance Standards are quoted at the bottom of the notice of proposed changes, so to use this resource for crib safety standards and disregard the age recommendations according to this resource discredits the source. This resource follows current research and practice, and the age definitions it offers are credible.
RESPONSE #19: The department reviewed recommendations and guidelines established through the American Academy of Pediatrics (AAP), the National Resource Center for Health and Safety in Child Care (NRCHSCC), Zero to Three and The National Association for the Education of Young Children (NAEYC). The department also contacted the National Child Care Information Center (NCCIC) and received additional information from surrounding states concerning infant/toddler care, ratios, and age definitions. The department took into consideration input from providers and conversations with other stakeholders including the State Fire Marshall. Although the proposed definitions vary slightly from some of the national resources, the proposed language allows the department to ensure that the particular requirements pertaining to infants and toddlers adequately meet the health and safety requirements in the state of Montana and further supports the direct input received from the various stakeholder groups. As such, the department thinks that the proposed changes are appropriate.
COMMENT #20: A commenter was concerned with ARM 37.95.1005(7)(a) as it references the American Academy of Pediatrics "Feet to Foot Rule" which is no longer recommended. The commenter suggested that this rule be eliminated from the proposed amendment to support the AAP's new policy statement.
RESPONSE #20: The department has chosen to allow a light-weight blanket for children while they are sleeping. The "Feet to Foot Rule" is no longer applicable due to the fact that the American Academy of Pediatrics no longer recommends using blankets for children under age one when they are napping. The department has chosen to allow light-weight blankets because the use of blankets is important to the culture of the families who place their children in care. The department has found through licensing surveys that parents are very vocal about allowing their infant to utilize blankets due to the climate in Montana as well as a source of comfort. Since the department is allowing light-weight blankets to be used, the department felt it was necessary to have specific parameters in place to ensure that the use and placement of the blanket is appropriate. As such, the department has proposed language that references the "Feet to Foot Rule."
COMMENT #21: A comment was made that "Infants only" was not updated to "children under age two" in three places in ARM 37.95.102(13)(a).
RESPONSE #21: The department agrees with this comment and the proposed rule under ARM 37.95.102(13)(a) has been amended. In addition, the department found that ARM 37.95.128 also needed to be amended as it referenced infants rather than children under age two.
COMMENT #22: A commenter questioned whether ARM 37.95.1002(2) was deleted entirely or just moved to a section regarding older children.
RESPONSE #22: The department proposed that ARM 37.95.1002(2) be moved under ARM 37.95.184(3) since the rule pertained to children of all ages.
COMMENT #23: A commenter asked about "one adult per child or one adult per four children" in ARM 37.95.132(8)(d).
RESPONSE #23: The intent of the rule states one adult per four children under age two.
COMMENT #24: A commenter asked why there was clarification under ARM 37.95.1003(2). The commenter stated a three year old should not be left unattended "from which they might fall either."
RESPONSE #24: This rule section is specific to infants and toddlers. The rule was written to pertain to that particular age group.
COMMENT #25: A commenter questioned about why the deadline for cribs to meet new requirements is not December 31, 2012 instead of December 28, 2012.
RESPONSE #25: The date used in the proposed rules is consistent with the date referenced by the Consumer Product Safety Commission.
COMMENT #26: A commenter asked about whether there will be a new term to replace "Infant Care Only."
RESPONSE #26: The department has not considered a title for this type of care at this time.
COMMENT #27: A commenter stated that a facility currently has three classrooms that pertain to ages addressed in proposed rule. One room has 0-12 months, the second is 12-24 months and the third is 24-36 months. The commenter questioned whether new rule would require them to separate 0-19 months and 19-24/36 months.
RESPONSE #27: The proposed rule amendment in ARM 37.95.1021(5) would not require children under age three to be split into infant and toddler groups. The rule allows for children 0-24 months to be mixed or if the facility chooses, they may also transition children over 18 months of age with older children. Basically, it is up to the facility to determine how classrooms are split as long as children under 19 months of age are not mixed with children over two years of age.
COMMENT #28: A commenter questioned about whether ARM 37.95.623(2) would allow for two children ages 16 months and two children age three as long as the lower ratio is met.
RESPONSE #28: No because this arrangement would not meet the proposed rule under ARM 37.95.1021(5) which states that play areas for infants must be separated from areas used by children over two years of age.
COMMENT #29: A commenter stated that ARM 37.95.1005(2) is not necessary for children over 12 months of age. The commenter questioned about whether the facility would be cited if a child was found on their stomach.
RESPONSE #29: The current proposed rule states that infants and toddlers shall be placed on their backs to sleep. In regard to the question about whether a facility would be cited if a child was found on their stomach, the decision to cite would be based on the situation observed. If an infant is capable of rolling from their back to stomach, the department does not expect the provider to move the infant back to a supine position. However, if an infant is laid down on their stomach (without a doctor note) regardless of whether they can roll or not, the department may choose to issue a deficiency for the noncompliance.
COMMENT #30: A commenter asked what a baby-feeding table was.
RESPONSE #30: A feeding table is a table with seats inserted into the table. There are several resources available online if one wishes to research these types of tables any further.
COMMENT #31: One commenter asked the department to change "toilet training" to "toilet learning" throughout in keeping with current language being used in child development and the Infant Toddler Caregiver certification course offered throughout the state of Montana.
RESPONSE #31: The department thinks that the language is sufficient as it is written and the suggested language changes are not significant enough to warrant a change at this time. This language is also consistent with language used by the American Academy of Pediatrics.
COMMENT #32: One comment was received concerning whether ARM 37.95.1001(7) is addressed elsewhere in the rule and whether there is a specific reference for children with special needs.
RESPONSE #32: The particular rule listed above is not referenced elsewhere for children with special needs. The department does not have specific rules pertaining to children with special needs. The department will consider this comment for future rule proposals.
COMMENT #33: A commenter suggested adding "guardians" after "parents" throughout the regulations to be inclusive of all families or clarify that "parent" includes legal guardian, etc.
RESPONSE #33: The department agrees that this language should be added and applied consistently. However, to simply change it in this section is not sufficient. There are sections outside of these proposed rules that would also need to be changed. The department will consider this change for future rule proposals and will include all applicable parts of the child care licensing rule.
COMMENT #34: One commenter asked the department to change the second sentence in ARM 37.95.1001(9) to state, "There shall be no routine attempt to begin toilet training with children . . .."
RESPONSE #34: The department thinks that the language is sufficient as it is written and the suggested language changes are not significant enough to warrant a change at this time.
COMMENT #35: A commenter suggested adding "the clothing must be placed in a sealed plastic bag and returned to the parent, guardian, or placement agency" in ARM 37.95.1002(1).
RESPONSE #35: The department agrees with this comment and has amended the proposed rule to include this language.
COMMENT #36: A comment was received that asked if the use of "play pen" in ARM 37.95.1005(3) aligns with new Consumer Product Safety Commission requirements cited in (4).
RESPONSE #36: The department understands that the Consumer Product Safety Commission (CPSC) will be looking closer at use of play pens over the next year. Once the CPSC concludes their review of play pens, and the findings of the review are known, the department will consider whether changes to the rules will be necessary.
COMMENT #37: A commenter asked if the phrase "as a regular sleeping option" could be added at the end of the sentence in ARM 37.95.1005(3)(a).
RESPONSE #37: The department thinks that the language is sufficient as it is written and the suggested language changes are not significant enough to warrant a change at this time. This rule has been amended due to comments listed in Comment #8.
COMMENT #38: A comment was received which questioned whether stackable cribs are allowed under new federal crib requirements.
RESPONSE #38: The department has reviewed the recent guidelines through the Consumer Product Safety Commission (CPSC). The new guidelines did not prohibit the use of stackable cribs; however, the traditional style of stackable cribs does not meet the current guidelines. The CPSC recommends that providers contact the manufacturer of the crib to ensure that a certificate of compliance can be obtained in order to show compliance with the new requirements.
As a result of this decree, the department has reviewed several companies that manufacture stackable cribs – cribs that slide under another crib. There are models available that meet the CPSC standard and have a certificate of compliance through the CPSC. The department will continue to allow the use of stackable cribs as long as they meet the CPSC guidelines. Since these types of cribs fall under the new guidelines, they are also subject to the December 28, 2012 deadline. After this date, the traditional style of stackable cribs will no longer be allowed for use unless the provider has a CPSC certificate of compliance.
COMMENT #39: In new crib regulations the term used for mesh and other soft-sided less than full-size cribs is "play yard." Montana may want to use language consistent with federal requirements to avoid confusion.
RESPONSE #39: The department thinks that the language is sufficient as it is written.
COMMENT #40: A commenter suggested adding "separately" after "shall be stored" in ARM 37.95.1005(8).
RESPONSE #40: The department thinks that the rule language is sufficient as it is written.
COMMENT #41: A commenter asked that ARM 37.95.1005(9) not be deleted. The commenter recommends the following wording in keeping with best practice - "Caregivers must be responsive to all cries of infants and toddlers."
RESPONSE #41: The rule was not proposed to be removed. It was simply renumbered. As to the rewording suggested by the commenter, the department considers that the language is sufficient as it is written and the suggested language changes are not significant enough to warrant a change at this time.
COMMENT #42: A commenter supported the addition of ARM 37.95.1005(10). The commenter questioned about whether the child care licensors will be verifying and enforcing this rule by checking all Professional Development Records through the Early Childhood Project web site for compliance.
RESPONSE #42: The department works closely with the Early Childhood Project to verify completion of training for child care providers. The department will continue this process as we implement the new requirements for the safe sleep curriculum.
COMMENT #43: Two commenters requested clarification about what defines a safe sleep environment.
RESPONSE #43: The department has written a definition for safe sleep environment. This definition will be added to ARM 37.95.102. As a result of this new definition, the section will be renumbered. Due to the addition of this definition, the department amended ARM 37.95.1005(11), also to specify that the proposed rule had to include a policy that described how a "safe sleep environment" rather than "safe sleep" would be promoted.
COMMENT #44: A commenter suggested deleting "walkers" from ARM 37.95.1011(2) as they are not allowed in the Environmental Rating Scales.
RESPONSE #44: The department agrees with this comment and has amended the proposed rule to include this language. This change is also consistent with the proposed rule change under ARM 37.95.1016(2).
COMMENT #45: A commenter suggested revising wording in ARM 37.95.1011(3) to align with current Montana Infant Toddler training course: "Each infant and toddler shall have individual positive interaction and responsive care with the same adult on a regular basis at least once each hour during non-sleeping hours to help develop a sense of trust and security. Examples include reciprocal listening and responding with verbal and nonverbal communication, holding, rocking, playing, and meeting individual basic needs through caregiving routines."
RESPONSE #45: The department thinks that the language is sufficient as it is written and the intent suggested by the commenter is met with the existing language.
COMMENT #46: A commenter suggested changing wording in ARM 37.95.1011(4) to ". . . to be taken outside for some period each day 'weather permitting' instead of 'in good weather'."
RESPONSE #46: The department thinks that the language is sufficient as it is written and the suggested language changes are not significant enough to warrant a change at this time.
COMMENT #47: A commenter suggested replacing the word "life" with "safety" in ARM 37.95.1015(2).
RESPONSE #47: The department agrees with this comment and has made the change as suggested, in ARM 37.95.1015(2).
COMMENT #48: A commenter asked the department to not delete "primary" in ARM 37.95.1012(3). There is solid research supporting the practice of each infant and toddler having a primary caregiver in child care. The commenter further stated that they did not understand the stated rationale for this change.
RESPONSE #48: The proposed changes were not intended to alter the intent of this rule. The rule as proposed still requires that each infant have a routine caregiver. The word "primary" was removed because the rule was confusing to individuals since "primary caregiver" is also a defined role of a caregiver. Individuals were unsure whether the rule required a regular "consistent" staff person or a caregiver listed as a "primary caregiver" to work with the infants. The proposed changes have provided clarification while maintaining the intent of the rule.
COMMENT #49: A comment was received regarding hand washing requirements in ARM 37.95.184. The comment states that requirements for hand washing for children should mirror those for adults. For example, children should wash their hands after using tissue for sneezing, blowing/wiping nose, coughing, etc.
RESPONSE #49: This particular comment is outside the scope of the proposed changes. The department agrees this is important and will consider for future rule changes.
/s/ Kurt R. Moser /s/ Anna Whiting Sorrell
Rule Reviewer Anna Whiting Sorrell, Director
Public Health and Human Services
Certified to the Secretary of State July 2, 2012